On Paper, Italy Allows Abortions, but Few Doctors Will Perform Them

ASCOLI PICENO, Italy — After Benedetta, 35, found out 11 weeks into her pregnancy that the baby she wanted “with all myself” had extremely serious genetic problems, she made a painful decision, and asked her longtime gynecologist for an abortion.

Her doctor’s refusal — she said she was a conscientious objector to Italy’s law that makes abortion legal up to 90 days — set off a desperate scramble to find a doctor who would help her.

At one hospital, doctors advised her to get a psychiatrist’s note saying she had threatened to kill herself, so that she could extend the legal time limit. At another, a doctor suggested that she just wait.

“ ‘The fetus is incompatible with life; you will very likely lose it anyway past the 20th week’ — that’s what this doctor told me,” Benedetta said, still angry and incredulous. She asked that her last name not be used to protect her privacy. “To expect a woman to see her belly growing, to raise a doomed life, is inhumane.”

“I felt like a container, not a human being,” she added.

After a fight that feminists in Italy still consider a signal achievement, abortion within 90 days of pregnancy — and later for women in mental or physical danger, or in cases of serious fetal pathologies — has been legal in this country for over three decades.

But that does not mean that finding a doctor to perform one is easy. Seventy percent of gynecologists — up to 83 percent in some conservative southern regions — are conscientious objectors to the law, and do not perform abortions for religious or personal reasons in a country that remains, culturally at least, overwhelmingly Catholic.

It is a circumstance that has alarmed some women’s health experts, who say that the challenges will grow only more severe in the years ahead.

“Most of the non-objectors like me are about to retire, so we will soon have troubles helping these women,” said Silvana Agatone, a 62-year-old gynecologist at a hospital in Rome and the founder of a website that provides information on how and where to get an abortion.

Dr. Agatone has conducted a yearslong phone survey, calling every hospital obstetrician unit she could locate to verify whether or not their doctors were conscientious objectors, and found that only 1,200 gynecologists out of well over 10,000 in Italy performed abortions.

According to a recent report, about 60 percent of Italian hospitals perform abortions, a declining but “more than satisfactory” number, the minister of health, Beatrice Lorenzin, wrote in a statement.

Experts agree that reproductive education has contributed to an overall decline in abortions in Europe. Abortion within the first trimester is legal in most European countries, even if with some restrictions.

The main difference in Italy, experts agree, is a shortage of doctors and centers willing to terminate a pregnancy. Moreover, the Roman Catholic Church’s opposition to the practice has created a stronger stigma here than in many other countries, they say.

In Italy, even at hospitals that ostensibly perform abortions, more individual doctors are opting out.

“I am Catholic and work for a Catholic hospital, so of course I don’t morally or practically endorse abortions,” said Marco Bonito, director of the obstetrics unit at the Catholic San Pietro Fatebenefratelli Hospital in Rome. “And I must say that, at least in the past, non-objectors were ghettoized in some cases, so we can’t rule out that that may have played a role in the low numbers” of doctors willing to perform abortions.

The issue is not as openly divisive in Italy as it is in the United States. Some Catholic anti-abortion movements hold rallies in city squares every once in a while, and local governments, on paper, do not obstruct abortion.

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“Most of the non-objectors like me are about to retire,” Dr. Silvana Agatone said.CreditNadia Shira Cohen for The New York Times

But in practice, some women face hurdles trying to gain access to abortion facilities in their regions, which the European Committee of Social Rights has deemed “detrimental” to their health.

“Women who are denied access to abortion facilities in their local region may, in effect, be deprived of any effective opportunity to avail of their legal entitlement to such services, as the tight time scale at issue may prevent them from making alternative arrangements,” the committee said.

Like Benedetta, many Italian women can recount similar stories of delayed diagnoses and troubles finding a hospital with a willing physician.

“We have a national law, we have had it since 1978 — it’s as old as my husband — and I have to drive through two regions to have an abortion?” said Silvia Brandimarte, 34, who was told her fetus had a serious genetic disease in her 12th week of pregnancy.

For her, too, the diagnosis set off a desperate hunt through several hospitals in the central Italian regions of Abruzzo and Marche before she finally found a doctor willing to terminate her pregnancy in September.

“Women doctors elsewhere just told me that they don’t offer that service — can you imagine?” she said. “I am not a teenager. I was raised in a Catholic family, one of those where ‘you keep what God gives you,’ but I do believe we have the right to choose.”

Noninvasive abortions can be equally challenging. Authorities in Marche, for example, never translated the national directives for the abortion pill RU486 into local protocols and guidelines. Thus, the pill that Italian women have theoretically been able to use since 2009 is still not available here.

The shortage of options for many women in the region has prompted the Italian Association for Demographic Education, or A.I.E.D., which performs outpatient services for a number of women’s health issues, to provide its own remedy. Once a week, it sends doctors who will perform abortions to Ascoli Piceno, in east-central Italy, from as far away as Milan and Rome. The city hospital did not have any gynecologists who terminated pregnancies.

Benedetta visited several centers before finding the A.I.E.D. doctors in Ascoli Piceno. After being turned down by two hospitals in the Marche region, a 39-year-old woman, who already had an 18-year-old daughter and was not in a position to have a baby, went to an A.I.E.D. doctor.

“I cried all through the procedure and after,” she said, asking that her name not be used to preserve her privacy. “And I still feel like a good Catholic.”

In a predominantly Catholic country, the sense of guilt for women who get abortions is still very strong, doctors and social workers in Ascoli Piceno said.

“It’s even made worse by wrong policies,” said Laura Olimpi, a pediatrician and the A.I.E.D chairwoman in Ascoli Piceno. “There is no intention to govern a decreasing phenomenon in the name of women’s health.”

Pope Francis has announced that all Roman Catholic priests have the power to offer absolution for the “sin of abortion” during the church’s Holy Year of Mercy, which began in December. Without changing the church’s orientation on the issue, Francis described “the scar of this agonizing and painful decision” in the hearts of many women he said he had met.

For some women, his words were a source of consolation in the emotional and therapeutic labyrinth they had to navigate.

“The first thing I thought when I heard it was, ‘Well, at least now he will absolve me,’ ” said a 38-year-old mother of two adopted children who decided, without her husband’s knowledge, to have an abortion for personal and economic reasons. She traveled more than 50 kilometers, or 31 miles, to have the procedure.

“It was not the right moment, and I knew it,” she said of having a baby. “Who are they all to judge me?”

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A version of this article appears in print on , on Page A14 of the New York edition with the headline: On Paper, Italy Allows Abortions, but Few Doctors Will Perform Them. Order Reprints | Today’s Paper | Subscribe